Provider Demographics
NPI:1053336289
Name:WHITMER, TEDDY JOE (APRN)
Entity type:Individual
Prefix:
First Name:TEDDY
Middle Name:JOE
Last Name:WHITMER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 E COUNTY ROAD 375 N
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:IN
Mailing Address - Zip Code:46128-9222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4829 E COUNTY ROAD 375 N
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:IN
Practice Address - Zip Code:46128-9222
Practice Address - Country:US
Practice Address - Phone:765-246-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002142363LF0000X
IN28128241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11564425OtherCAQH
Q71519OtherUPIN
IN200885980Medicaid